Consultant plastic Surgeon and head , Institute of Aesthetic Surgery , Apollo Hospitals, Hyderabad and eye cancer expert was recently chosen for the esteemed Colonel Rangachari Gold Medal Award and the Hanumantha Reddy Award for a year 2010 at the annual conference of all Indian Ophthalmological society. Dr Debraj Shome is the youngest ever recipient of this Award which bears testimony to the exceptional work being done by him.

Dr. Debraj Shome is also the first Indian recipient of the Davies foundation Grant Award by the Royal College of Surgeons, Glasgow, UK. This is awarded to two physicians every year for physicians who have performed sterling work in cancer research and therapy and have contributed to life saving research.

Raj Shankar in conversation with Dr. Debraj Shome…

HI: How different was your research and finding on eye cancer from that of other researchers and doctors ?

Dr. Debraj Shome: Radically different clinical trials have already demonstrated the efficacy of intra venous {injected thru blood steam} carboplatin therapy in the management of retinoblastoma {RB}. Systemic chemotherapy coupled with appropriate focal therapy has become a current standard of care in the management of these eye tumours. However, systemic chemotherapy is associated with its own risks. The regiments currently used can cause transient neutropenia , anemia and thrombocytopenia that may require blood product transfusion s, and organ toxicities including ear toxicity, kidney toxicity and liver toxicity. This is especially true in children as many children even die not from cancer per se but from the drugs injected.
We have actually started “local” injection of carboplatin around eye so that damage to the normal cell of the body is negligible!

HI: What was your research and how did you hit upon this route?

Dr. Debraj Shome:In a landmark series of experiments, our group has come closer to treating this eye cancers as well as soon neural cancers better. The first step occurred when Dr.Santosh Honavar of LV Prasad Eye Institute Hyderabad and I at the Tata Memorial Centre Mumbai started using carboplatin injections locally instead of intra-venously{through the blood} to treat children with eye cancers. The rational for using local {around the eye} carboplatin injections was to increase the concentration of the drug with in the eye without incurring additional systemic toxicity from increasing intra venous dosages. This was extremely successful and more than 60% of the children treated benefitted from this regimen.

After the success of the first trial, we hypothesized that reducing the size of the drug molecule may further increase concentration in the body. Hence, our group created a novel nanomolecule carboplatin for the local injection. We found as much as 11 times greater penetration into the body with this never drug as compared to the carboplatin drug available in the market. This was a huge breakthrough.”

The problem however for our group was that a nanomolecule without a protein based had never been produced anywhere in the world, not only for carboplatin,but also for any chemotherapy ever targeted against the brain and the eye cancer. The group kept working on the process and finally have developed a PMMA based nanomolecule of carboplatin. Poly methyl methacrylate {PMMA} is a bio-neutral substance and is used commonly for lenses used post cataract surgery. it has a long history of complete safety. This is the first time that PMMA has ever used been used in developing this revolutionary new nano-molecule of carboplatin which is now being used in trial in cancer patients.

First ever carboplatin molecule so altered in the world, for greater penetration into tissues.

Research published in top international research journal.

Phase III: developing another nano-molecule of carboplatin. More advanced than phase II as this molecule does not have any protein and is carried by PMMA, a completely bio inert and safe substance to the human body. {2009}
First time ever any chemotherapy drug used against brain and eye cancers has been produced without proteins anywhere in the world.

Phase IV {in the future}: create never drug delivery mechanisms to introduce the drug inside the organ such as the eye and the brain, like eye drops, etc.

HI: How does it help in treating eye cancers better?

Dr. Debraj Shome: These local injections with the newly invented nano-molecule of carboplatin enter the eye better, raise the local concentration of the drug and cause increase the death of tumour cells. Most importantly, the collateral damage to normal blood cells is absent as this rout does not go thru the blood.!

HI: What are carboplatin injections?

Dr. Debraj Shome: Carboplatin is a platinum based agent which is used as a chemotherapeutic agent in the management of retinoblastoma {RB}.Systemic chemotherapy coupled with appropriate focal therapy has become a current standard of care in the management of these eye tumours.!

HI: Using carboplatin injections locally helps in better outcomes, but does it also kill healthy cells?

Dr. Debraj Shome: No, it does not!

HI: What is the outcome of your studies? Are the kids able to see better and do they live longer?

Dr. Debraj Shome:The long-term impact of this nano-moleculeand its local injection is still being studied but preliminary results make this revolutionary molecule seem very promising in.
A}. making children live longer.
B}. Improving their quality of life, precluding the side effects of systemic chemotherapy.
C}. Preserving the eyes in much larger percentage of kids, preventing enucleation
{Eye removal} and helping them see better
This has huge impact for society as RB affects young kids less than 2 years of age and kids blinded, debilitated or dead is a huge loss socially and financially to the country.!

HI: Why do some kids not respond to this line of treatment?

Dr. Debraj Shome: This depends on when they present to us. If the disease is very advanced and has already spread to the brain, the impact of any medication is poor.

HI: How do you do patient selection?

Dr. Debraj Shome: Don’t know how to answer this. Everyone with this tumour or any other neural tumour can potentially benefit from this revolutionary research.

HI: How common is Retinoblastoma {RB} one of the commonest primary eye cancers?

Dr. Debraj Shome: It is the commonest eye cancer and occurs in 1 in about 10,000 live births!

HI: What cause Retinoblastoma {RB}?

Dr. Debraj Shome: A faulty gene, coupled with same environmental factors, including marrying close relatives and some other environmental factors, that we currently do not completely understand!

HI: Is it hereditary?

Dr. Debraj Shome: A portion of patient with RB do have hereditary disease {about 40%}.Those who have hereditary disease typically have multiple tumour and in both eyes!

HI: Is there any genetic research going on in this field to find the rogue gene that cause RB?

Dr. Debraj Shome: The gene has been identified about three decades ago. Research is on genetically engineer that particular gene!

HI: Where was the study done?

Dr. Debraj Shome: This study has been led by Dr. Debraj Shome from Apollo Hospitals, Hyderabad who led the multi-centric trial, Dr. Jayesh Bellare and his team from the Indian Institute of Technology, Mumbai were instrumental in developing the new molecule.

HI: What is the future in this field?

Dr. Debraj Shome: I would love to design in my life eye drops which just be put into the eye and could go into the retina of these babies and treat their cancer, without need for subjecting these gentle creatures to any injections. That seem really tough given the current available technology, but we promise to try really hard and have already started working in the direction!